Provider Demographics
NPI:1831805316
Name:BECKER, DAWN MARIE
Entity type:Individual
Prefix:MISS
First Name:DAWN
Middle Name:MARIE
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TEAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MINOA
Mailing Address - State:NY
Mailing Address - Zip Code:13116-1126
Mailing Address - Country:US
Mailing Address - Phone:315-720-7927
Mailing Address - Fax:315-445-8421
Practice Address - Street 1:JAMESVILLE DEWITT MIDDLE SCHOOL
Practice Address - Street 2:6280 RANDALL RD
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078
Practice Address - Country:US
Practice Address - Phone:315-445-8258
Practice Address - Fax:315-445-8421
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604330-01163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool